Association of ambient air pollution with cardiovascular disease risks in people with type 2 diabetes: a Bayesian spatial survival analysis
Abstract Background Evidence is limited on excess risks of cardiovascular diseases (CVDs) associated with ambient air pollution in diabetic populations. Survival analyses without considering the spatial structure and possible spatial correlations in health and environmental data may affect the preci...
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doaj-ebc172f3905e4f8da9569e188be085732020-11-25T04:07:21ZengBMCEnvironmental Health1476-069X2020-11-0119111210.1186/s12940-020-00664-0Association of ambient air pollution with cardiovascular disease risks in people with type 2 diabetes: a Bayesian spatial survival analysisPei-Fang Su0Fei-Ci Sie1Chun-Ting Yang2Yu-Lin Mau3Shihchen Kuo4Huang-Tz Ou5Department of Statistics, National Cheng Kung UniversityDepartment of Statistics, National Cheng Kung UniversityInstitute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung UniversityDepartment of Statistics, National Cheng Kung UniversityDivision of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical SchoolInstitute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung UniversityAbstract Background Evidence is limited on excess risks of cardiovascular diseases (CVDs) associated with ambient air pollution in diabetic populations. Survival analyses without considering the spatial structure and possible spatial correlations in health and environmental data may affect the precision of estimation of adverse environmental pollution effects. We assessed the association between air pollution and CVDs in type 2 diabetes through a Bayesian spatial survival approach. Methods Taiwan’s national-level health claims and air pollution databases were utilized. Fine individual-level latitude and longitude were used to determine pollution exposure. The exponential spatial correlation between air pollution and CVDs was analyzed in our Bayesian model compared to traditional Weibull and Cox models. Results There were 2072 diabetic patients included in analyses. PM2.5 and SO2 were significant CVD risk factors in our Bayesian model, but such associations were attenuated or underestimated in traditional models; adjusted hazard ratio (HR) and 95% credible interval (CrI) or confidence interval (CI) of CVDs for a 1 μg/m3 increase in the monthly PM2.5 concentration for our model, the Weibull and Cox models was 1.040 (1.004–1.073), 0.994 (0.984–1.004), and 0.994 (0.984–1.004), respectively. With a 1 ppb increase in the monthly SO2 concentration, adjusted HR (95% CrI or CI) was 1.886 (1.642–2.113), 1.092 (1.022–1.168), and 1.091 (1.021–1.166) for these models, respectively. Conclusions Against traditional non-spatial analyses, our Bayesian spatial survival model enhances the assessment precision for environmental research with spatial survival data to reveal significant adverse cardiovascular effects of air pollution among vulnerable diabetic patients. Graphical abstracthttp://link.springer.com/article/10.1186/s12940-020-00664-0Time-to-eventSurvivalSpatial correlationBayesian approachCardiovascular diseaseType 2 diabetes |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Pei-Fang Su Fei-Ci Sie Chun-Ting Yang Yu-Lin Mau Shihchen Kuo Huang-Tz Ou |
spellingShingle |
Pei-Fang Su Fei-Ci Sie Chun-Ting Yang Yu-Lin Mau Shihchen Kuo Huang-Tz Ou Association of ambient air pollution with cardiovascular disease risks in people with type 2 diabetes: a Bayesian spatial survival analysis Environmental Health Time-to-event Survival Spatial correlation Bayesian approach Cardiovascular disease Type 2 diabetes |
author_facet |
Pei-Fang Su Fei-Ci Sie Chun-Ting Yang Yu-Lin Mau Shihchen Kuo Huang-Tz Ou |
author_sort |
Pei-Fang Su |
title |
Association of ambient air pollution with cardiovascular disease risks in people with type 2 diabetes: a Bayesian spatial survival analysis |
title_short |
Association of ambient air pollution with cardiovascular disease risks in people with type 2 diabetes: a Bayesian spatial survival analysis |
title_full |
Association of ambient air pollution with cardiovascular disease risks in people with type 2 diabetes: a Bayesian spatial survival analysis |
title_fullStr |
Association of ambient air pollution with cardiovascular disease risks in people with type 2 diabetes: a Bayesian spatial survival analysis |
title_full_unstemmed |
Association of ambient air pollution with cardiovascular disease risks in people with type 2 diabetes: a Bayesian spatial survival analysis |
title_sort |
association of ambient air pollution with cardiovascular disease risks in people with type 2 diabetes: a bayesian spatial survival analysis |
publisher |
BMC |
series |
Environmental Health |
issn |
1476-069X |
publishDate |
2020-11-01 |
description |
Abstract Background Evidence is limited on excess risks of cardiovascular diseases (CVDs) associated with ambient air pollution in diabetic populations. Survival analyses without considering the spatial structure and possible spatial correlations in health and environmental data may affect the precision of estimation of adverse environmental pollution effects. We assessed the association between air pollution and CVDs in type 2 diabetes through a Bayesian spatial survival approach. Methods Taiwan’s national-level health claims and air pollution databases were utilized. Fine individual-level latitude and longitude were used to determine pollution exposure. The exponential spatial correlation between air pollution and CVDs was analyzed in our Bayesian model compared to traditional Weibull and Cox models. Results There were 2072 diabetic patients included in analyses. PM2.5 and SO2 were significant CVD risk factors in our Bayesian model, but such associations were attenuated or underestimated in traditional models; adjusted hazard ratio (HR) and 95% credible interval (CrI) or confidence interval (CI) of CVDs for a 1 μg/m3 increase in the monthly PM2.5 concentration for our model, the Weibull and Cox models was 1.040 (1.004–1.073), 0.994 (0.984–1.004), and 0.994 (0.984–1.004), respectively. With a 1 ppb increase in the monthly SO2 concentration, adjusted HR (95% CrI or CI) was 1.886 (1.642–2.113), 1.092 (1.022–1.168), and 1.091 (1.021–1.166) for these models, respectively. Conclusions Against traditional non-spatial analyses, our Bayesian spatial survival model enhances the assessment precision for environmental research with spatial survival data to reveal significant adverse cardiovascular effects of air pollution among vulnerable diabetic patients. Graphical abstract |
topic |
Time-to-event Survival Spatial correlation Bayesian approach Cardiovascular disease Type 2 diabetes |
url |
http://link.springer.com/article/10.1186/s12940-020-00664-0 |
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